Teen Hospital Stays for Childbirth: Latest National and State Specific Trends

Teen pregnancy rates in the U.S. remain high with significant variation among states in both pregnancy rates and teen hospital stays for childbirth, according to a recent brief from the Agency for Healthcare Research and Quality (AHRQ). Entitled Teen Hospital Stays for Childbirth, 2004-2013,1 the report compares hospital-acquired data for teens aged 15-19 years old, including a comparison to the data of adult pregnant women and costs by insurance type. The AHRQ report and recent CDC data provide interesting insights on national trends and significant state-level differences in teen pregnancy rates and hospitalizations for childbirth and the impact on healthcare payers, particularly Medicaid which pays for 70 percent of teen hospital stays for childbirth.

National Trends in Teen Pregnancy

“The teen birth rate has declined almost continuously over the past 20 years,” according to the U.S. Office of Adolescent Health.2 A CDC report in June of 2016 showed an 8 percent decrease in the U.S. teen pregnancy rate in 2015 among 15-19-year-olds.3 This CDC report also stated a 46 percent overall decrease since 2007.

Meanwhile, the AHRQ statistical brief showed that the teen pregnancy rate increased from 2004-2006, before beginning to decrease in 2007. Wide variation in decreases between the states was also noted in all three sources—with the lowest decrease occurring in Southern states.

Hospitalizations for Childbirth Among Pregnant Teens

For 2013, the AHRQ report showed 265,370 maternal hospital stays, of which 73,570 were for females between 15-17-years-old and 72.3 percent for 18-19-year-olds. Further, AHRQ found that the average length of hospital stay (LOS) was 2.6 for both 15-17-year-olds and 18-19-year-olds. Data analysis was based on hospital stay of the mother rather than birth data.

The number of pregnant teen hospital utilizations for childbirth corresponded regionally to:

Northeast: 30,135 maternal stays (16.2 stays per 1,000 females)

Midwest: 55,615 maternal stays (14.0 stays per 1,000 females)

South: 120,865 maternal stays (52.3 stays per 1,000 females)

West: 58,755 maternal stays (23.3 stays per 1,000 females)

Health Insurers and Teen Pregnancy

The national cost for 2013 for childbirth was $311 million in teen females aged 15-17, plus $818 million in teen females aged 18-19, per the AHRQ report. Medicaid programs pay about 70 percent of the cost of teen childbirth. In contrast, 23 percent was covered by private insurance health plans.

The difference between payers of hospital costs for pregnant females aged 15-19 versus pregnant adult females aged 20-44 are presented for comparison in the AHRQ report, as shown in the following:

Payers for maternal stays of females aged 20-44 years:

Medicaid = 1,428,125

Private insurance = 1,803,655

Medicare or other = 130,210

Uninsured = 95,175

Payers for maternal stays of females aged 15-19:

Medicaid = 190,645

Private insurance = 60,830

Medicare or other = 6,885

Uninsured = 6,580

State Medicaid Expenditures for Teen Childbirth in Hospitals

The expected payer for childbirth among females aged 15-19 in hospitals in Florida in 2013 was Medicaid (81.3 percent) per the AHRQ report. This was followed by Georgia (79.3 percent). In contrast, private payers were expected to cover costs in Florida and Georgia for 14.3 percent and 13.3 percent, respectively. The states with the next two highest Medicaid percentages—after Florida and Georgia—were Connecticut (78.6 percent) and California (78.5 percent).

Private Health Insurance Spending for Teen Childbirth in Hospitals

The three states where private insurance was the foremost payer for childbirth hospitalizations of pregnant teens in 2013 were as follows:

Nebraska (60.6 percent)

Minnesota (44.6 percent)

Utah (35.6 percent)

Complications of Pregnancy in Teens

It is well-recognized among physicians that pregnant teens are at higher risk of anemia, pre-eclampsia, and poor fetal growth than adult pregnant women. The AHRQ report data showed comparative maternal complication percentages by age category as follows:

The five states with the highest percentages of poor fetal growth among hospitalized pregnant females aged 15-19 in 2013 were:

South Carolina (6 percent)

West Virginia (6 percent)

Rhode Island (5.9 percent)

Kentucky (5.8 percent)

Georgia (5.4 percent)

State Hospitalization Comparison for Teens – Pre-Eclampsia

Pre-eclampsia is a potentially life-threatening pregnancy complication. The five states with the highest percentages of pre-eclampsia/eclampsia among hospitalized pregnant females aged 15-19 in 2013 were:

Georgia (11.3 percent)

Rhode Island (11.3 percent)

Tennessee (11.3 percent)

North Carolina (11.2 percent)

Kentucky (10.9 percent)

States with Highest and Lowest Childbirth Hospitalization Rates

The AHRQ report presented the states with the highest childbirth hospitalization rates for pregnant teens from 2004-2013 as:

Arkansas (ranging from 40.3 – 57.9)

West Virginia (ranging from 38.6 – 40.7)

Texas (ranging from 37.6 – 57.1)

Kentucky (ranging from 36.4 – 45.3)

Arizona (ranging from 31.2 – 56.2)

The three states with the lowest rates were all located in New England (Massachusetts, Connecticut, and Vermont).

From 2004-2013, the largest decrease in the rate of teen hospital stays for childbirth was in Connecticut.

Neighborhood Incomes and Pregnant Teens

For pregnant teens between 15-19 years old who were hospitalized for childbirth in 2013, the AHRQ report showed that 43.3 percent resided in neighborhoods that were linked to incomes at the lowest quartile of the U.S. population. In major contrast, only 8.1 percent of the pregnant teens resided in neighborhoods in the highest-income quartile.

For adult pregnant women, only 26.4 percent lived in areas at the lowest quartile, while 22.6 percent lived in the highest-income quartile—showing far less difference in neighborhood income level than among pregnant teens.

Disparities in Teen Pregnancy Rates

The teen birth rate among Hispanics and non-Hispanic African Americans remained nearly twice that of the non-Hispanic white population in 2014, according to the CDC’s Morbidity and Mortality Weekly Report (MMWR) in 2016.

Nationally, from 2006 to 2014, the teen birth rate declined 41% overall with the largest decline occurring among Hispanics (51%), followed by blacks (44%), and whites (35%).

Additionally, this MMWR reported that “unemployment was higher, and education attainment and family income were lower in counties with higher teen birth rates.”

The authors of the report also stated that some states showed smaller disparities in teen pregnancies “because the teen birth rates were relatively high among all racial/ethnic groups”. As an example, they identified Arkansas as having a teen birth rate higher than the national average for Hispanics (46.5 percent), African Americans (54.6 percent), and Caucasians (37.7 percent).

Uninsured Young Pregnant Women

Rural areas and micropolitan areas (urban areas between 10,000 and 50,000 in total population) were noted in the AHRQ report as having higher levels of teen childbirth hospitalizations than large metropolitan centers. In 2014, 11 percent of 18-year-olds were still uninsured, according to a U.S. Census Bureau report issued in September 2015.

Meanwhile, the AHRQ report found a higher teen pregnancy rate among 18-19-year-olds (44.1 per 1,000) as compared to 15-17-year-olds (11.7 per 1,000)—at a total cost in 2013 of $818 million for the 18-19-year-olds versus $311 million for the 15-17-year-olds. Therefore, lack of health insurance coverage for pregnant women who are 18-19 years old remains an economic burden to hospitals.

Highlights of Report on Teen Hospital Stays for Childbirth:

To summarize, here are the highlights from AHRQ’s statistical brief:

In 2013, childbirth was the leading reason for teen hospital stays, constituting nearly half of all inpatient hospitalizations among females aged 15–19 years.

Of the 265,370 teen hospital stays for childbirth in 2013, which amounted to $1.1 billion in hospital costs, over 70 percent were paid by Medicaid.

The rate of teen hospitalizations for childbirth increased from 2004 through 2007 from 41.8 to 44.5 stays per 1,000 females aged 15–19 years but thereafter decreased to 24.9 in 2013.

From 2007 through 2013, the rate of childbirth hospitalizations decreased faster for teens aged 15–17 years than for those aged 18–19 years (50 vs. 42 percent decrease).

Across States, the rate of teen hospitalizations for childbirth varied by a factor of 3.

The rate of teen hospitalizations for childbirth was highest in the South at 80.5 in 2004. Through 2013, the rate decreased by 35 percent in the South compared with a decrease of over 40 percent in other regions. Thus, the rate in the South (52.3) remained higher than in any other region in 2013.

Teen hospital stays for childbirth also were highest and declined the least in low-income, micropolitan, and rural areas.

Although teens were less likely to have a C-section than women aged 20–44 years, they were more likely to have preeclampsia or eclampsia, poor fetal growth, and anemia.

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The Piper Report blog on healthcare business and policy covers issues in Medicaid, Medicare, and the Affordable Care Act, with articles, interviews, resources, primers, book reviews, and more. Edited by Kip Piper, MA, FACHE.